Capsular contracture remains the most common complication of aesthetic breast augmentation despite advances in the understanding of the biological processes which appear to be involved. The role of biofilms in capsular contracture has been reported extensively and is believed to play an important role in the pathogenesis of capsular contracture. Recent advances in antibiotic irrigation as well as the use of skin barriers and nipple shields has assisted in the reduction of capsular contracture. Form stable implant studies with textured devices have also shown lower capsular contracture rates compared to smooth round devices. Yet, despite these advances, a significant number of women develop capsular contracture following breast augmentation and require revisional surgery or live with discomfort, deformity, or suboptimal results.
Three cysteinyl leukotrienes, LTC4, LTD4, and LTE4 are products of arachidonic acid metabolism and are released from cells associated with the inflammatory response. These compounds bind to cysteinyl leukotriene receptors which are found on smooth muscle cells and inflammatory cells. When leukotrienes bind to the cysteinyl leukotriene receptor, multiple effects including cellular contraction, edema, and altered cellular activity associated with inflammation may occur. Montelukast (Singulair) inhibits the actions of one leukotriene, LTD4, at the cysteinyl leukotriene receptor. Zafirlukast (Accolate) is a competitive receptor antagonist for leukotrienes, and is known to antagonize the contractile activity of three different leukotrienes, including LTC4, LTD4, and LTE4. These leukotrienes are associated with the inflammatory process, smooth muscle and cellular contraction. Zafirlukast (Accolate) competitively inhibits three different leukotrienes, rather than the one leukotriene inhibited by Montelukast (Singulair).
The use of leukotriene inhibitors for the treatment of capsular contracture was reported as early as 2002, and multiple studies have shown benefits in softening breasts and reducing the severity of capsular contracture with either Singulair or Accolate. However, the prophylactic use of these medications immediately postoperatively, and before there is any evidence of capsular contracture in the patient is unknown. Additionally, methods for the effective prophylactic treatment of patients undergoing revisional surgery for capsular contracture are unknown. Currently, there is no clear standard of care for the use of these off-label medications, and little information is available regarding effective methods in their use in treating and preventing capsular contracture in patients. Accordingly, improved methods for the prevention and treatment of capsular contracture in patients is desirable.